Ninety years ago, a German scientist named Otto Walberg put forward a theory of cancer that was to radically alter the way we think about this devastating disease. However, a change in thinking would not happen immediately. It would take many years before his theory finally gained ground. In 2014 there is increasing attention being paid to the work of Otto Warburg and the implications his theory has for the prevention, cause and treatment of cancer. The journey has really only just begun…

‘Could we have mischaracterized the true nature of cancer?’

I have just finished reading Tripping Over the Truth by Travis Christofferson. As I closed the last page, I turned back to the first and started it again. That’s how good this book is. In fact, I don’t know if I can do it justice but here goes…

I first heard about Travis via an article he posted on Robb Wolf called The Origin of Cancer last year. I thought it was one of the most fascinating articles* I had ever read and was keen to find out more about the foundation Single Cause Single Cure, which Travis founded. I had also been interested in the work of Dr Colin Chapman, Professor Thomas Seyfried and Dr Dominic D’Agostino and their research into ketogenic diet therapies for cancer using the Warburg Hypothesis, so Travis’s article sparked a real desire to learn more about the metabolic theory of cancer. As I always say about Paleo, I was led down the proverbial rabbit-hole of discovery and so I was very excited to hear that Travis had written a book which was released in the UK last month.

This book will hook you from the first page. Firstly, I want to say that it is neither a medical textbook nor a heavy scientific tome that will require prior knowledge to understand its argument (although I had read the excellent The Emperor of All Maladies by Siddhartha Mukherjee, which gives an overview of the story of cancer.*) Tripping Over the Truth is for everyone; doctors, patients, medical professionals or simply people like me who are interested in this field of cancer research and the possibilities of nutritional therapy as an aid to treatment. It is an incredibly well-crafted, easily-read and profoundly moving account of the fight against cancer, detailing a theory of its origins that was all but forgotten save for a handful of scientists over the last 100 years.

As we know all too well, each of us has been touched by cancer in some way. It is hard to write about, to read about and to talk about yet as Travis points out, one in two men and one in three women will be diagnosed at some point in their life. It is all around us, yet we are silenced by it. These figures are astounding.

Tripping Over the Truth takes us on a journey from the Chimney Boys of Percival Potts 19th Century London and the discovery of carcinogens to the very latest drugs such as 3BP and therapies such as Hyperbaric Oxygen Therapy (HBOT) and the Restricted Ketogenic Diet (R-KD). We learn about chromosomal abnormalities of cancer cells, about viral infections, the discovery of DNA and its implications for cancer research, the advent of chemotherapy (born from the toxic weapons of World War II), Nixon’s ‘War on Cancer’ and the new generation of drugs such as Herceptin that target oncogenes (genes that have the potential to cause cancer).

We discover why much of what we know about the prevention, causes and treatment of cancer is rooted in a deeply-held belief about its origins which – at its very core – may be erroneous. To say that writing a book like this will bring Travis in for some hard criticism is an under-statement. As with anyone involved in this area of research, going against the conventional thinking in the fight against what is undoubtedly our most feared disease will invite much condemnation, as well as praise.

This book questions why a cure for cancer continues to hover outside of our reach. Why have we not seen the breakthroughs that we hoped? Why does the complexity of the disease continue to confound scientists? Why have the billions that we have spent on research not succeeded in improving overall death rates since the 1950s? These are questions that must be asked if we are to move forward in our understanding of cancer.

Current thinking posits the origins of cancer as resulting from damage to our DNA; the genetic or Somatic Mutation Theory (SMT) of cancer. This idea dominates research and since the remarkable discovery of DNA in the 1950’s, it has been the one overarching theory that researchers hoped would unite cancer research and provide the elusive cure. Travis describes how the ongoing project The Cancer Genome Atlas which was started in 2006 aims to sequence the entire genome of a cancer cell (all the DNA inside the gene) and thus elucidate the mutations that cause the disease. When Travis looked at the research coming out of this project, he was struck by the failure to provide consistent data along with its apparent randomness: ‘No single mutation or no combination of mutations could be identified that were absolutely required for the disease to start.’ In addition to this, Travis explains that the new drugs developed to target these mutations have not lived up to their promise for the following two reasons:

1.‘TCGA failed to identify the mutations that definitively caused any given type of cancer’ and

2. ‘The mutational targets are not only vastly different from person to person, but they can even vary spectacularly from cell to cell within the same tumour.’

‘Comprehensive sequencing was unable to find a single mutation responsible for the most important quality of cancer, the single feature of cancer responsible for 90% of all cancer deaths’ (metastasis).

It is particularly upsetting to hear of the failure of many targeted therapy drugs; with 700 alone being tested in the past decade. Travis quotes Antonio Tito Fojo PhD of the National Cancer Institute in Bethesda: ‘Zero is the number of targeted therapies that have prolonged survival by one year, when compared to a conventional treatment.’

In contrast to the SMT theory, Travis explains how the concept of cancer as a disease of ‘defective metabolism’ first put forward by Otto Walburg takes a different approach. We can define metabolism as the range of biochemical processes that occur within a living organism, including the breakdown of food and its transformation into energy. Warburg’s observation that cancer cells generate most of their energy from glucose (sugar) through the process of fermentation rather than through respiration via oxygen posits a root cause to the disease.

‘The reversion from aerobic to anaerobic energy creation was the signature that defined the difference between cancer cells and normal cells. Nothing was more fundamental to a cell than energy creation. Nothing could be further reduced.’

The uptake of glucose can be detected clinically by positron emission tomography (PET) scans. The metabolic theory places genetic mutation and a host of other symptoms as secondary side effects, rather than as causes. However, it was largely ignored.

Travis discusses the work of Pete Pederson, whose research continued to focus on the Warburg hypothesis from the 1970s onwards and who has been one of the few consistent voices in the metabolic theory of cancer. His discovery of the corruption of the protein Hexokinase by Hexokinase II in the 1970s, which resulted in the abnormal overproduction of cells was an important development in metabolic theory research. Pederson’s lab made the further discovery that Hexokinase II binds to another protein called VDAC (voltage dependant anion channel) and thus effects the ability of the cell to self-destruct (apoptosis) resulting in the proliferation of cancer cells. We also learn how Pederson’s student Dr Young Ko worked beside him to develop the drug 3BP which targets the metabolism of cancer cells and which may offer promising treatment when funding is obtained and trials are completed.

Travis highlights the work of Professor Thomas Seyfried at Boston University and in particular his seminal book ‘Cancer as a Metabolic Disease’ (2012) which expands the Warburg theory even further. When the energy-generating powerhouses in our cells called mitochondria suffer damage they begin to send out signals that result in changes to the ‘entire complexion of the cell.’ These destabilising changes include the way that cells generate energy, pushing them over to fermentation rather than oxygenation and also resulting in the genetic mutations that we see in cancer cells.

Professor Seyfried uses a restricted ketogenic diet R-KD in his practice; in particular in the treatment of aggressive brain tumours. This diet naturally reduces calories (as it has been shown that calorie restriction shrinks tumours) but it also does something else: through the restriction of carbohydrates and protein together with high amounts of fat, the diet forces the body to manufacture ketones as an alternative fuel source in the absence of glucose. Cancer cells cannot use ketones; only normal cells can make the switch and the R-KD starves cancer cells of their energy. You can read more about the ketogenic diet in Jimmy Moore’s latest book Keto Clarity and for therapeutic use in cancer treatment, check the links at the bottom of the page.

In addition to this, Travis describes how Seyfried discovered the R-KD was ‘antiangiogenic – it choked off the production of new blood vessels supplying the tumour’ as well as being ‘proapoptotic, in that it facilitated orderly cell death.’ By weakening cancer cells, the diet can be used as a way to prepare the body for additional conventional treatments and mitigate their side-effects.

‘Seyfried modified the ketogenic diet to put as much metabolic stress on the cancer cell as possible.’

As we know, the ketogenic diet has been used since the beginning of the 20th Century to treat epilepsy, falling out of favour with the rise of seizure-control drugs. Charities such as Matthew’s Friends in the UK and The Charlie Foundation in the US are at the forefront of raising awareness and promoting research into ketogenic therapies for epilepsy and related neurological disorders, but there is also a growing interest in using this dietary therapy for cancer patients (alongside conventional treatments). The 4th Biannual Ketogenic Dietary Therapies Symposium took place in Liverpool UK this year and doctors such as Dominic D’Agostino and Professor Adrienne Scheck attended. With 500 representatives from 27 countries, the conference is becoming increasingly popular and with the amazing work done by Matthew’s Friends and the Charlie Foundation, press awareness continues to grow, such as in articles here and here.

In addition to ketogenic diet therapies, the development of Hyperbaric Oxygen Therapy (HBOT) alongside the R-KD is an exciting development that Travis describes. He tells us how Dr Dominic D’Agostino (see the resources at the bottom of this article for more on Dr D’Agostino) and Professor Seyfried have combined the two therapies with promising results. Through his work with Navy SEALS researching methods to prevent seizures from oxygen toxicity, Dr D’Agostino discovered that cancer cells were irretrievably damaged in the presence of high levels of oxygen. As Travis notes, these two therapies represent ‘a massive step in the direction of cheap, nontoxic, effective health care’ but warns ‘It is not unrealistic to expect friction.’ There is no money to be made in these sorts of therapies and as Travis notes, in terms of opposition, therein lies the problem.

‘When cancer is framed as a metabolic disease, the entire paradigm of treatment is turned inside out.’

The metabolic theory of cancer and books such as Tripping Over the Truth offer new hope, but Travis stresses the importance that (as in all good science) there must always be room for the prospect of error or revision: ‘It may be that the SMT of cancer and the metabolic theory are intertwined – a chimerical monster, existing in two realms at once.’ Indeed, eradication of this disease may never be achieved but as Travis notes our understanding of cancer is still in its infancy. Despite this, perhaps we are turning a corner in the prevention, treatment and ultimately the cure of cancer.

I really cannot recommend this book highly enough. The work of these pioneering researchers deserves a wide audience. Yes, it is controversial. Anything that deals with the subject of cancer ultimately is because we are so fearful to even discuss it, let alone depart from conventional thinking with regards to its cause and treatment. This horrible disease touches all of us in some way and yet when I began researching the subject and reading only a tiny fraction of the information out there, I realised I knew nothing about it. Yet the story of cancer is a gripping and spellbinding odyssey that transcends disease and cuts to the heart of what it means to be human, to be mortal. Tripping Over the Truth shines a light on our most feared enemy and encourages us to understand the potential we have at our fingertips to exploit its greatest weakness. Time will tell if we are successful, but for now let’s hope that things are about to change.

‘The therapeutic implications of metabolic therapy are that every type of cancer is treatable, because every type of cancer has the same, beautiful, metabolic target painted on its back, regardless of origin or type of cancer.’

Thank you to Travis Christofferson, Robb Wolf and all those people who work relentlessly to bring the metabolic theory of cancer and the work of these researchers to a wider audience.

Listen to an interview with Travis Christofferson on Robb Wolf’s podcast here.

*It was through Travis’s original article that I discovered the book The Emperor of All Maladies by Siddhartha Mukherjee and ordered it immediately. If you have not read this book, please do. It is a breath-taking achievement and brilliantly written. It puts the history of humanity’s battle with this terrible disease into perspective and gives a primer for reading subsequent works such as Tripping Over the Truth (although Mukherjee’ theory is firmly placed in genetics).

Resources

As well as the links above, here are a few more websites, articles and videos. Many of these are also listed over on the Resources pages and I will be adding to these as time goes on.

I am a big fan of Jimmy Moore. He has tirelessly and fearlessly charted his health journey over many years in full glare of the public eye. He has been unafraid to discuss his struggle or to challenge and debate alternative views via his extremely successful podcasts and blog. He has a thirst for knowledge which I admire and also a strong desire to help others who have suffered – or continue to suffer – with health issues. His story is one that many of us can identify with and because of this; he has a huge and loyal fan base.

The latest book Keto Clarity is written with co-author Dr Eric C. Westman and is a follow on to the extremely successful Cholesterol Clarity that they released last year. Jimmy and Dr Westman have assembled an impressive array of experts from the medical and nutritional world to discuss ketogenic diets and provide a thorough and definitive guide to a very misunderstood way of eating.

For those of you unfamiliar with Jimmy’s story, he saw amazing health results after starting the Atkins diet in 2004 and began blogging about low carbohydrate high fat diets in 2005 in an effort to help others and spread the word. You can read more about Jimmy’s story here. The shift to a fully ketogenic diet seems a natural transition for Jimmy and there is no doubt when reading the book and listening to Jimmy’s podcasts, he is experiencing many benefits brought about by ketosis. Dr Westman is Associate Professor of Medicine at Duke University in Durham, NC, and Director of the Duke Lifestyle Medicine Clinic, specializing in disease prevention and the treatment of obesity and diabetes. Dr Westman also co-wrote New Atkins for a New You with Dr Stephen Phinney and Dr Jeff Volek.

I read this book in record time – I couldn’t put it down! I would say that the first thing that struck me is how incredibly easy to read it was. I’m not one to shrink from trying to understand detailed medical texts (although Peter Dobromylskyj at the excellent Hyperlipid has me stumped much of the time). I was anticipating quite a hard read, having not read Cholesterol Clarity. I needn’t have worried – everything in this book is superbly explained and very clearly laid out. The text is interspersed with ‘Moments of Clarity’ quotes from ketogenic experts, as well as ‘Doctor’s Notes’ from Dr Westman. At the end of each chapter there are handy bullet points that succinctly sum up the information contained in the text. There is also a fantastic resources section at the back of the book with medical papers, book lists, websites and even films that relate to the ketogenic diet; a real wealth of information for anyone interested in finding out more.

Many people that follow Paleo are well-researched in the ketogenic diet. The benefits of switching from the standard high carbohydrate, low fat diet to one that is rich in fat and lower in carbohydrates brings a myriad of benefits that Paleo adherents can testify to, not least of which the absence of hunger and the ability to go for long periods without food. A ketogenic diet takes these practices one step further. However, the debate within the community concerning carbohydrates and ‘safe starches’ shows no sign of abating and the issue of ketosis continually crops up. As always, I try to keep an open mind on the various arguments and go along with the importance of tailoring the diet according to the individual’s medical history, combined with the ‘experiment and see how you feel’ school of thought. However, I do believe that the ketogenic diet as a therapeutic tool in the treatment of various conditions is proving to be an exciting field of research and if this is true, then it may act as a preventative measure too.

In Keto Clarity, we learn exactly what a ketogenic diet entails and the many benefits that it brings about. For those of you who are new to a ketogenic diet, this is a high fat, moderate protein, low carbohydrate diet. Typically this would be less than 50 grams of carbohydrate per day and around 80 grams of protein per day (this varies according to the individual and ketone testing is necessary to determine optimum levels). The remainder of the daily calorific requirement (again varying between individuals) should be made up of fat. Fat equates to typically around 70-80% of calories. Short- and medium-chain fats such as butter and coconut oil are preferable as they convert easily to ketones. Some people supplement with MCT oil and there is also research into ketone ester supplements that help to push ketone levels up.

Excess carbohydrates and protein will push the body out of ketosis and precipitate a return to carbohydrates as the primary fuel source. Jimmy notes:

‘If you are especially sensitive to carbohydras (like me) then you will be more sensitive to protein.’

In view of this, fatty meat is preferred over lean because of the fat ratio and portion sizes need to be controlled.

As a response to this way of eating, the body switches from burning carbohydrates for fuel to fat for fuel and this brings about a myriad of benefits including mental clarity, stabilized blood sugar, lowered blood pressure, reduced triglycerides, reduced inflammation, increased energy, the list goes on and on… There are many who believe that a ketogenic state is the preferred, natural state for us to be in and that evolutionary speaking, it is one in which we would have spent the majority of our time. There is an argument that we may have cycled in and out of ketosis according to food sources, availability, seasons etc. That can be (and currently is) debated until the cows come home so I am leaving it up to you to read up on the various arguments for and against. I think that Jimmy puts it perfectly:

‘Ketosis is something you may want to pursue if you are dealing with weight or health issues and you are not getting the results you desire with your current strategy.’

Upon reading about the many benefits and therapeutic effects, a ketogenic diet may be something that some people will wish to explore, not only for the treatment of specific diseases but as a preventative measure. Keto Clarity gives them the perfect starting point.

I found the history of ketogenic diets and their current use in a variety of conditions particularly interesting. They have been used in the treatment of epilepsy and seizures since the 1920s but were superseded when new drugs appeared in the 1950s. Therapeutic ketogenic diets are still used now and you can find out more about this at websites such as The Charlie Foundation and Matthew’s Friends.

To successfully remain in ketosis it is important to find your personal carbohydrate and protein threshold, so the success of this diet involves a fair amount of self-experimentation. An excess in either of these will bump you out of ketosis. It is very easy to over-consume carbohydrates and if protein levels are too high, the liver will convert excess protein to glucose via gluconeogenesis (although again this is a debated point – see the article from Ketotic here). Jimmy explains clearly how to go about testing for ketones. There are currently 3 methods to do this – each measuring different ketone bodies:

a) Urine strips which measure acetoacetate in the urine such as these. As ketones become the primary source of fuel, the body switches to Beta-hydroxybutyrate, so urine strip readings will decrease although you are still in ketosis. For that reason it is essential to use an additional method of testing

b) Blood meters which measure Beta-hydroxybutyrate in the blood such as these.

c) Breath meters which measure acetone in the breath – Ketonix is a new device on the market. Acetone correlates to Beta-hydroxybutyrate so is a more reliable method of testing than urine strips. I have been reading some reviews of this device and they have been very positive.

Testing is essential and Jimmy lists the pros and cons of each method. He also stresses the fact that just because a person is following a low-carb diet, this does not guarantee that they will be in a state of ketosis. Tinkering around with macro-nutrient ratios according to your personal requirements is the key here! At the time of writing, Jimmy was eating 80% fat, 15% protein and 5% carbohydrate.

‘Knowing the difference between how you feel in and out of ketosis is key.’

There is a great chapter on trouble-shooting, with tips to help you overcome the most common mistakes as well as a FAQ chapter that deals with some of the more contentious issues around ketosis (such as the effect on thyroid and adrenal function). I was particularly interested in the subject of gut microbiota in relation to ketosis after reading this article by Jeff Leach over at Human Food Project. It will be interesting to see how Jeff’s research pans out. The book goes on to address criticisms of the diet in a clear and easy to understand way – it really is essential reading for anyone that is confused by the conflicting arguments out there at the moment.

The culmination of the book – and probably my favourite part – is the chapters that deal with current research on the therapeutic effects of the ketogenic diet. They are split into three distinct sections: ‘Solid Science’, ‘Good Evidence’ and ‘Emerging Areas’. These chapters are preceded by an excellent guide to using the current information out there with a clear explanation of the various types of studies used in medical research: epidemiological, observational, controlled etc. Knowing how to isolate the strong and relevant studies from the thousands of papers published each year is crucial.

It is absolutely fascinating to read about the various conditions that are currently treated with ketogenic diets, as well as some of the emerging areas of study. I have reproduced the list of these in full below as it exciting to see the importance of nutrition coming into play in such a wide range of health problems. It is worth researching the ketogenic diet if you suffer from any of these. This information is supplemented by an extensive list of research papers at the back of the book.

Keto Clarity finishes with some shopping lists, recipes and meal plans to get you started and as well as the excellent Resources section there is even a Glossary of frequently used terms.

This really is a great book for anyone interested in ketogenic diets. Jimmy Moore and Dr Eric Westman have done a fantastic job in bringing together vast amounts of information into a concise and enjoyable read.

What is clear from reading this book, and particularly reading some of stories of people who are finding benefits from the ketogenic diet, is that increasingly we are turning to n=1 experiments to treat a variety of conditions. Physicians may still be reluctant to recommend the ketogenic diet as a therapeutic tool – see for instance this story behind Matthew’s Friends – but those who are prepared to investigate may just find unexpected success. The research is clearly taking off and is much needed, but there is a whole community of people that are willing to experiment themselves rather than wait for randomized controlled trials to be published. Some may warn against this and argue that people should wait to hear conclusive evidence before embarking on a ketogenic diet. However, this diet is not a new development or fad and there is already a hefty body of research behind it, together with nearly 100 years of experience in using ketosis to treat epilepsy. As discussed in the context of an evolutionary perspective, ketosis may be a perfectly natural and preferred state for the body given that we went for long periods without food and mostly favoured high fat meat with limited carbohydrates (yes, I know about the Kitavans…). This is an extremely exciting time for nutritional research and I expect to hear much more about the benefits of a ketogenic diet in the years to come. Well done for Jimmy Moore and Dr Westman for helping to bring the ketogenic diet to a whole new audience.